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gastroenterology , hepatology and nutrition > Gastric cancer > Flashcards

Gastric cancer Flashcards

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1
Q

gastric cancer is classified into benign and malignant what are the benign tumors ?

A

epithelial - adenoma

mesenchymal - leiomyoma , fibroma , hemangioma , lipoma , neurinoma

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2
Q

what are the malignant neoplasms of the stomach ?

A

adenocarcinoma

adeno-squamous carcinoma

squamous cell carcinoma

small cel carcinoma

gastric MALT lymphoma

GIST - gastrointestinal stromal tumor

leiomyosarcoma

neuroendocrine tumors - carcinoids

metastatic - melanoma and breast

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3
Q

what is the most common malignant cancer in the stomach ?

A

adenocarcinoma

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4
Q

adenocarcinoma is histologically classified into what categories ?

A

Lauren classification :

intestinal

diffuse type

and mixed morphology

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5
Q

describe intestinal gastric adenocarcinoma ?

A

majority of patients have this

different grades due to different differentiation usually retained glandular structure
minimum invasiveness
SHARP margins

associated with atrophic gastritis - intestinal metaplasia and dysplastic changes
often polypoid or exophytic bulky lesions

associated with environmental risk factor and diet

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6
Q

describe diffuse type of gastric cancer according to lauren classification

A

infiltrative - into the stomach wall without making obvious mass lesions/ deceptive margins - ulcerating lesions
and often intraperitoneal metastasis

WORST PROGNOSIS - POORLY DIFFRENTIATED - SIGNET RING CELLS

no associated with environmental risk factors and diet - more often in younger population and and family history of E catherine mutations

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7
Q

what is a diffuse type of gastric cancer according to lauren classification called ?

A

LITNIS PLASTICA - submucosal spread

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8
Q

what are the epidemiological factors in diffuse type and intestinal type gastric cancer

A

in intestinal type - most often affecting elder age

in diffuse type - often affecting younger age

in diffuse type - women affected more than man

and intestinal type- man more than women

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9
Q

what causes a higher risk for diffuse ype of gastric cancer occurring?

A

blood type A

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10
Q

how does intestinal type of gastric cancer spread ?

A

Early hematogenous rouute

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11
Q

how does the diffuse type of gastric cancer spread ?

A

Late lymphatic regionally and transmurally

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12
Q

in the cardia of the stomach the most common type of gastric cancer is ?

A

diffuse type

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13
Q

in the corpus antrum of the stomach the most common type of gastric cancer is ?

A

intestinal type

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14
Q

what are the established risk factors for gastric cancer ?

A

over 60

familial

geographical - japan , korea , south america

blood group A

smoking

helicobacter pylori infection

heavy metal exposition

nutrition - salt intake , tinned food , fried food , ad fatty food , alcohol , dyes , plastic packaging

high intact of zinc or copper in drinking water

previous gastric surgery / gastrectomy

pernicious anemia - atrophic gastritis

obesity - gastric cardia

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15
Q

helicobacter pylori infection increases the incidence of what type of gastric cancer the most ?

A

intestinal type in the corpus and antrum

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16
Q

what are the specific carcinogens for causing gastric cancer ?

A

nitrosamines , benspirene aflatoxin

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17
Q

what type of food gives protection for gastric cancer ?

A

fresh fruits and veg - tomatoes , onion , strawberries , grapes

aspirin

content of vit c , vit E , sélénium

b carotene

milk products , green tea

freshly cooked food

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18
Q

what is the change in the prevalence of the type of stomach cancer ?

A

the intestinal type has reduced however the diffuse type remains unchanged

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19
Q

what has happened to incidence of gastric cancer ?

A

it has decreased also its premalignant conditions

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20
Q

h pylori increases the chance of what type of gastric cancer ?

A

intestinal type

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21
Q

how does h pylori cause gastric cancer ?

A

long term sequel - through inflammation , atrophy , gastritis and achlorhydria and increase gastrin levels

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22
Q

the clinical outcome of H p infection is determined by what ?

A

pathogenic potential of the hp strain

and the secretory status

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23
Q

in what case does hp infection lead to higher risk of acquiring cancer ?

A

in low hcl secretion - ph of more than 4
hp progresses into pangastritis
chronic atrophic gastritis
and malignant transformation

hypo and achlorhydria

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24
Q

in what case does hp have more risk for becoming ulcers ?

A

in high hcl secretion = ph of less than 2
mainly leading to antra gastritis
increase gastrin secretion and HYPERCHLORHDRIA

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25
which strains of h pylori are associated with increased risk for gastric cancer ? and why ?
CagA (+) due to increased colonisation in the gastric epithelium and pathogenicity and induce secretion of IL-11/ 17 LESS GASTRIC acid secretion and more inflammation
26
WHAT ARE THE HERIDITORY RISK FACTORS FOR GASTRIC CANCER ?
hereditary diffuse gastric cancer - autosomal dominant E- cadherin gene non polyposis colorectal cancer FAP - familial adenomatous polyposis peutz jeghers li - fraumeni syndrome
27
hereditary etiology has what type of gastric cancer ?
diffuse gastric cancer
28
hereditary diffuse gastric cancer also increases the risk for what types of cancer ?
breast cancer , colorectal cancer
29
what is the criteria for genetic counselling in hereditary diffuse gastric cancer ?
one relative with histologically confirmed diffuse type GC before 50 years of age two relatives wit histologically confirmed diffuse HG at any age leading to screening and prophylactic gastrectomy
30
what are the precancerous conditions for stomach cancer which are very rare ?
atrophic gastritis - chronic autoimmune gastritis =15-20 percent infections with h pylori = less than 1 percent gastric polyposis - has some sort of connection where gastric cancer was found concomitant with adenomatous polyposis which was synchronous and metachronous - so gastric polps are removed due to the possibility in progression to neoplasia as a preventive measure gastric ulcer
31
what ca be the primary prophylaxis of gastric cancer ?
screening and eradication of hp in young screening of risk group such as relatives of first degree , or hereditary gene mutation , over the age of 50 - through fluoroscopy , endoscopy , blood work all patients with dyspepsia should be screened clinically and endoscopically good nutrition chemoprevention by giving cox 2 inhibitors - celecoxib and indomethacin Polypectomy new blood test for cancer screening proposed in japan IgG antibodies against Hp pepsinogen 1 and pepsinogen 2 acyl greyly and deacyl greyly
32
there are four macroscopic forms of gastric cancer ?
polypoid - most likely the intestinal type ulcerated infiltrative mixed forms
33
with the diffuse the of gastric cancer what is there an excess production of ?
mucin production | - lintis plastica
34
what is the japanese classification of early gastric cancer ?
protruding (polyp like) ``` superficial - (gastritis like) elevated plaque flat plaque depressed plaque confined to the mucosa ``` excavated (ulcer like) - the lowest point is in the submucosa
35
which lymph nodes does gastric cancer metastasise into ?
the perigastric lymph nodes
36
what are the symptoms go GC ?
unspecific early symptoms / or no symptoms at all. heaviness after meals and stomach discomfort - patient begins to feel his stomach. belching distension of epigastrium early satiety epigastric pain - NOT THE INITIAL SYMPTOM dyspepsia nausea and vomiting advanced gastric cancer : weight loss / loss of appetites bleeding from GIT anemia
37
when endoscopy is done special attention to be paid to if there is ?
Local hyperemia Local whitening Abnormal vascular pattern
38
how do we diagnose gastric cancer ?
1) upper Gi tract endoscopy with biopsy 2) CT with oral intravenous contrast 3) complete blood count 4) endoscopic ultrasound if no M1 disease is found pathological pseudo kidney in epigastrium in advanced stages of CA
39
how many biopsies should be taken when diagnosing gastric cancer ? and where are the taken from ?
6-10 biopsies 6-10 biopsies from the base and from the four quadrants of the edges more malignant tissues are present in th edge that the necrotic crater or centre
40
metastasis of gastric cancer location is where ?
direct - momentum , pancreases , diaphragm to the ovaries - tumor of krukenberg and the douglas space to the liver periumbilical
41
dd of gastric cancer ?
chronic gastritis chronic callus gastric ulcer benign stomach tumors
42
what is the treatment of gastric cancer ?
stage 1 - endoscopic mucosal or endoscopic submucosal resection more than stage 1 - preoperative chemotherapy surgery - partial gastrectomy , / lymphnodectomy splenectomy / total gastrectomy and post operative chemotherapy stage 4 - palliative radiotherapy - decreases bleeding , obstruction pain surgery - pain relief and oral intake of food palliative chemotherapy
43
in metastatic stage 4 gastric cancer as chemotherapy what is given to achieve partial response and increase survival ?
FAM - 5FU ,adriamycin , mitomycyn C
44
how to treat gastric malt lymphoma ?
low grade malignancy - complete resolution of neoplasm high grade malignancy eradication of just h pylori is not only recommenced
45
neuroendocrine gastric tumors of less than how many cm are of low risk ?
1cm
46
neuroendocrine tumors of bigger than what cm are at high risk ?
2cm or more can metastasise
47
neuroendocrine tumors arise in two pathways which are ?
de novo malignant transformation - single , larger and more aggressive loss of normal response to high serum gastrin multiple and smaller size neoplasm
48
what Lethe protective factors for neuroendocrine tumors ?
aspirin
49
what are the risk factors specifically for neuroendocrine tumors ?
heavy smoking | family history or first line relatives of colorectal cancer
50
GIST tumors are what kind of tumors ?
gastrointestinal stromal tumors arise from the interstitial cells of Canal
51
what size predictable for the GIST tumor to be malignant ?
2-3cm
52
GIST tumors respond to which type of treatment the best and why ?
GIST are kit positive (tyrosine kinase and CD 117 ) respond well to tyrosine kinase inhibitors - imatinib
53
what type of cells are founding the carpia of the stomach ?
mucus secreting cells
54
what is found in the antrum and the pylorus of the stomach ?
mucus producing and neuroendocrine cells
55
gastric cancer is usually located where ?
40 percent the lower part 40 percent the middle part incidence in the upper part such as the cardia of the stomach is increasing and the lower part is increasing
56
eradication of h pylori is absolutely necessary when ?
patents with family history of gastric cancer
57
in the pathophysiologof h pylori what type of cascade is triggered when infected with h pylori to lead to malignancy ?
correa cascade
58
h pylori usually affects for what part of the stomach ?
antrum , body , fundus. NOT CARDIA
59
what are the late complications of gastric cancer ?
pleural effusion ascites gastric outlet obstruction intra or extra hepatic jaundice
60
what are the signs for gastric cancer
low serum iron accl ESR - medium late stage : palpable enlarged stomach with succession splash hepatomegaly metastasis - sister mary joseph nodule virchow gland irish node blumer shelf - shelf like tumor anterior rectal wall
61
what are the paraneoplastic syndrome in gastric cancer ?
dermatomyositis acanthus nigerians circinate erythema peripheral thrombophlebitis
62
if there is metastasise found in gastric cancer what testing should be done ?
microsatellite instability and deficient mismatch repair system HER-neu and PD-L1
63
when does endoscopic ultrasound become useful when detecting gastric cancer
when CT fails to define T and N stage this can view the depth of the tumor
64
what is the staging of gastric cancer ?
Tis -carcinoma in situ - without invasion of lamina propria T1 - invades lamina propria but limited to the submucosa T2 - tumor invades muscular propria T3 - subserosal connective tissue invasion T4 - tumor invades the serosa or adjacent structures
65
what are the early post operative complications in gastric cancer ?
anastomotic failure cholecystitis pancreatitis
66
what is the classification of MALT lymphoma ?
b cell non hodgkin lymphoma categorised as either gastric or non gastric
67
what is the etiology of gastric malt lymphomas ?
h pylori
68
what is the etiology of non gastric Malt lymphoma ?
autoimmune diseases such as hashimoto thyroiditis , shores syndrome
69
adenocarcinoma of the stomach is histologically divided into ?
-papillary -tubular mucinous -signet ring cell
70
adenocarcinoma of the stomach is locally classified into
cardia - esophageal like gastric cancer - distal stomach like cardia gastric cancer non carda - diffuse - intestinal
71
what is another classification for early gait cancer ?
Borman classification
72
describe borman classification ?
polypoid ulcerating ulcerating and infiltrating infiltrating- litnis plastica
73
what is the definition of early gastric cancer
Early gastric cancer (EGC) is defined as invasive gastric cancer that invades no more deeply than the submucosa, irrespective of lymph node metastasis

gastroenterology , hepatology and nutrition (34 decks)

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